Provider Tools

Referral Forms

Bridging the Gap Between Primary Care and Behavioral Health

CCNC, in partnership with other stakeholders, has developed a set of three referral forms for primary care and behavioral health providers to facilitate easier consultation and communication. Initially released in Spring 2012, the forms have been updated based on feedback received from our partners. A summary of revisions to the forms is available here and instructions for using the forms are available here.

Form #1 – Behavioral Health Request for Information – this form is for behavioral health providers who begin working with a new consumer or identify a potential medical need, and wish to make contact with the PCP.